Legal and Ethical Issues Related to Psychiatric Emergencies

Legal and Ethical Issues Related to Psychiatric Emergencies

Ohio State Laws on Emergency Holds

Psychiatric Mental Health Nurse Practitioners (PMHNPs) are critical in effectively managing psychiatric emergencies. Management of psychiatric emergencies is guided by specific state laws that govern different processes, such as emergency holds (Hedman et al., 2016). In Ohio, Section 5122.10 of the Ohio Revised Code offers guidelines for involuntary psychiatric emergency holds for children and adults. The law allows doctors, health officers, police officers, probation officers, and sheriffs to take a person into custody if they believe they are mentally ill and need hospitalization. The professional also needs to ascertain that leaving the patient at liberty may pose a significant risk of harm to others and oneself (Ohio Legal Rights Service, 2010). The law also permits professionals to take patients to mental health or general hospitals. During admission to the facility, a written statement should be presented by the professional detailing the reasons for holding the patient.

Upon the individual’s arrival, the hospital has until twenty-four hours to examine the patient. If the patient was taken to a general hospital, they must be transferred to a hospital supervised and licensed by the state’s Department of Mental Health. If the individual needs to stay overnight, they get admitted under “unclassified” status (Ohio Legal Rights Service, 2010). If the chief clinical officer determines that the patient needs hospitalization, the individual may be detained for up to three court days. During that period, the clinical officer may admit individuals as voluntary patients or file an affidavit seeking a temporary detention order. If the court fails to issue temporary detention, the law requires the individual to be discharged upon expiration of the three-day (72-hour) period (Ohio Legal Rights Service, 2010). For children, the parent or caregiver should be present during discharge to pick them up.

Psychiatric Hold vs. Inpatient and Outpatient Commitment

There are key differences between emergency hospitalization for psychiatric hold and inpatient and outpatient commitments. Emergency psychiatric holds take a relatively shorter period of up to 72 hours. On the other hand, inpatient and outpatient commitments take relatively longer periods, ranging from days to weeks. In inpatient commitment, the patient receives treatment while admitted to the hospital, while in outpatient commitment, patients do not need to stay overnight in the hospital (Disability Rights Ohio, 2016).

Capacity vs. Competency

Effective management of psychiatric emergencies also needs an understanding of the concepts of capacity and competency. Capacity determines whether a person can make a medical situation in any given scenario, while competency refers to a person’s ability to participate in legal proceedings (Libby et al., 2018).

Legal and Ethical Principles in Mental Health Care

Ethical principles act as practice guidelines for PMHNPs. One of the most relevant ethical topics in psychiatric emergencies is patient autonomy. Essentially, patient autonomy refers to the right of patients to make informed decisions about their treatment. Patients’ autonomy may be compromised in psychiatric emergencies due to impaired decision-making capacity (Becker & Forman, 2020). Therefore, healthcare professionals may authorize treatment to help restore the patient’s autonomy in such cases. Specific legal issues are also associated with patient autonomy in psychiatric emergencies, such as obtaining patient consent. It is essential for health care professionals to obtain consent from the legal caregiver or the patient once decision-making capacity is regained.

Suicide Risk and Violence Risk Assessment Tools

Various suicide and violence risk assessment tools have been developed over the years. An example of a tool often used in suicide risk assessment is the Columbia-Suicide Severity Scale (C-SSRS). The screening tool can be used for children, adults, and children. Essentially, it helps assess both passive and active suicidal ideas and suicidal behavior. The tool can be accessed at https://cssrs.columbia.edu/. On the other hand, an evidence-based violence risk assessment example is the Historical, Clinical, Risk-20 (HCR-20). This tool includes 20 key violence risk factors that can be used to assess adults and is available at http://hcr-20.com/.

References

Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in Psychiatry, 11, 127

Disability Rights Ohio. (2016). Civil Commitment: Understanding Your Rights. Retrieved from https://www.disabilityrightsohio.org/assets/documents/dro_civil_commitment_april2016.pdf

Hedman, L. C., Petrila, J., Fisher, W. H., Swanson, J. W., Dingman, D. A., & Burris, S. (2016). State laws on emergency hold for mental health stabilization. Psychiatric Services, 67(5), 529-535.

Libby, C., Wojahn, A., Nicolini, J. R., & Gillette, G. (2018). Competency and capacity. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532862/

Ohio Legal Rights Service. (2010). A Comparison of the Affidavit and Emergency Hospitalization Methods. Retrieved from https://nisonger.osu.edu/images/odhp/First%20Responder%20Resources/ohio-involuntary-civil-commit-process.pdf

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Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

Explain the difference between capacity and competency in mental health contexts.
Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
Identify one evidence-based suicide risk assessment that you could use to screen patients.
Identify one evidence-based violence risk assessment that you could use to screen patients.
Attach copies of or links to the suicide and violence risk assessments you selected.